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Pitfalls in MR Image Interpretation Prompting Referrals to an Orthopedic Oncology Clinic¹

¹ From the Department of Radiology, University of Chicago Hospitals, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637. Recipient of a Certificate of Merit award for an education exhibit at the 2005 RSNA Annual Meeting. Received March 17, 2006; revision requested August 14 and received August 25; accepted August 28. Authors have no financial relationships to disclose. Address correspondence to G.S.S. (e-mail: sstacy{at}radiology.bsd.uchicago.edu).

Patients referred to the authors’ hospital for evaluation on suspicion of a bone or soft-tissue malignancy frequently present to the Orthopaedic Oncology Clinic with magnetic resonance (MR) images that show typical features of nonmalignant or nonneoplastic entities. The purpose of this article is to review the benign entities that may be mistaken by the radiologist for a malignancy and thus lead to needless referral to an orthopedic oncologist. Normal hematopoietic marrow and marrow edema due to a stress reaction may mimic a neoplasm at MR imaging, but knowledge of the typical patterns and locations of these features allows an accurate radiologic interpretation. The MR imaging appearance of osteonecrosis, Paget disease, benign bone lesions, and rheumatologic conditions may be confusing; in such circumstances, radiographic findings may help formulate a correct diagnosis. Knowledge of the common locations and appearances of bursae and ganglia is necessary so that radiologists do not misinterpret these benign entities as soft-tissue sarcomas. Soft-tissue trauma and inflammation also may mimic tumors at MR imaging, but a familiarity with the imaging patterns of nonneoplastic change in muscle allows the avoidance of misinterpretation. The clinical history, as always, is an important component of proper diagnosis. The radiologist can be especially useful to both the clinician and the patient by recognizing entities that are highly unlikely to represent malignancy and by confidently reporting those entities as benign, thereby sparing the patient an unnecessary trip to the orthopedic oncologist.

© RSNA, 2007

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Invited Commentary • Authors’ Response

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RadioGraphics 2007 27: 827-828. [Full Text] [PDF]

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				L. W. Bancroft, G. S. Stacy, and L. B. Dixon Invited Commentary * Authors' Response RadioGraphics, May 1, 2007; 27(3): 827 - 828. [Full Text] [PDF]